PB1923: PATIENT AND PHYSICIAN CHARACTERISTICS ASSOCIATED WITH HYPOMETHYLATING AGENT USE IN HIGHER-RISK MYELODYSPLASTIC SYNDROMES
Authors: A. Zeidan, V. Divino, M. DeKoven, D. Shah, E. Wang, D. Bey, T. Salimi, R. Epstein
Journal: HemaSphere (2022)

Background: Hypomethylating agents (HMAs) decitabine and azacitidine are recommended standard of care treatment for patients with higher-risk MDS (HR-MDS). However, real-world studies have revealed underutilization of HMAs among HR-MDS patients in clinical practice, leading to suboptimal outcomes. Aims: This study evaluated patient and physician characteristics associated with use vs non-use of HMA therapy among HR-MDS patients in US clinical practice, in order to better understand trends and potential barriers to optimal HMA utilization. Methods: This was a retrospective longitudinal cohort study using the IQVIA PharMetrics® Plus database, which contains adjudicated claims from over 190 million unique patients in the US. Patients included in the study were adults newly diagnosed with HR-MDS from January 1, 2017 to December 31, 2019 who had ≥1 inpatient or ≥2 outpatient claims >60 days apart with diagnosis codes for high grade MDS lesions or refractory anaemia with excess blasts (RAEB). Patients also had to have continuous enrolment for 6 months prior to and following the index date (date of first claim), with variable follow-up (up to 12 months) through June 30, 2020. Logistic regression analysis was used to evaluate predictors of HMA use. Results: Of 366 included patients, only 128 (35.0%) received HMA therapy, while 238 (65.0%) did not. The HMA group had a numerically higher proportion of male patients (61.7 vs 55.5%), were younger (mean age, 67.5 vs 70.4 years), had lower comorbidity burden (Charlson Comorbidity Index [CCI] ≥3, 29.7 vs 34.5%), and were more likely to be commercially insured (46.1 vs 34.9%) than patients in the no HMA group. Logistic regression analysis demonstrated similar trends (Figure): patients aged 55-64 and 65-74 years had numerically higher odds of receiving HMA therapy (odds ratio [OR] 2.29, p=0.05, and 2.04, p=0.11, respectively) than those aged ≥75 years (OR 1.13, p=0.79; reference group 18-54 years); females were less likely to receive HMA therapy than males (OR 0.65; p=0.09); and patients with a baseline performance status proxy for disability were significantly less likely to receive HMA treatment than those without (OR 0.28, p<0.01). Additionally, patients with red blood cell (RBC) or platelet transfusion were >4-times more likely to receive HMA therapy (OR 4.09, p<0.0001). Comparison of physician characteristics between the HMA non-prescribing vs HMA prescribing groups did not show significant differences in terms of age (54.5 vs 52.2 years; p=0.13), sex (69.7 vs 75.6% male; p=0.34), specialty (hematologist/oncologist, 90.5 vs 86.8; p=0.58), years since graduation (28.2 vs 25.4 years; p=0.09), or region of the US (p=0.74). Image:Summary/Conclusion: This real-world analysis confirmed prior observations that among HR-MDS patients in the US, utilization of HMA therapy is low. Patients receiving HMA therapy tended to be younger and with a lower burden of comorbidity or disability, suggesting possible barriers to prescribing HMAs to older, frailer patients. Receipt of RBC/platelet transfusion was also significantly associated with HMA prescribing, suggesting physicians may be influenced by the potential to avoid or reduce the need for RBC/platelet transfusion with HMA therapy.